Abstract

Immune reconstitution inflammatory syndrome is an inflammatory reaction in HIV-infected patients after initiation of
antiretroviral therapy resulting from restored immunity to specific infectious or non-infectious antigens. A 36-year-old
male patient on highly active antiretroviral therapy of six months duration, presented with reddish, tender lesions over
medial aspect of arm and a single, anaesthetic patch. Tender fluctuant swellings were seen on the medial aspect of left
forearm. A few of them had ruptured spontaneously discharging pus. A skin biopsy from the anaesthetic patch showed
caseating epitheloid granulomas. A diagnosis of Hansen’s disease borderline tuberculoid in type 1 reversal reaction, with
formation of nerve abscess due to Immune Reconstitution Inflammatory Syndrome was made. The patient was started
on multibacillary multidrug therapy as per WHO guidelines and highly active antiretroviral therapy was continued.